Left Atrial Diverticulum Associated With Severe Mitral Regurgitation

Terada, Hirokazu; Tanaka, Yasuhiro; Kashima, Katsurou; Sannou, Kazuhisa; Arima, Terukatsu

doi:10.1253/jcj.64.474

Cited by 27 publications

(39 citation statements)

References 6 publications

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“…A more recent study by Abbara et al actually identified accessory diverticulae as having linear structures suggesting pectinate fibers at their orifice [15]. Atrial diverticulae, but not atrial aneurysms, are thought to contain myocardial sleeves, and thus, should demonstrate contraction during the cardiac cycle [4]. Such changes have been found in pulmonary vein ostia during atrial contraction, which demonstrate significant changes on size detected with cardiac CT or MRI [16].…”

Section: Discussionmentioning

confidence: 99%

“…Other sites have also been shown to give rise to complex fragmented atrial electrograms (CFAE), including the interatrial septum, left atrial appendage and left atrium roof [3]. Small accessory appendages arising from the left atrial wall have also been identified with cardiac CT, which have been referred to variably as aneurysms or diverticulae [4,5]. Pathologically, a diverticulum contains normal myocardial wall structure and contracts in synchrony with the rest of the atrium, whereas aneurysms do not contain myocytes and therefore do not exhibit contractile properties [4].…”

Section: Introductionmentioning

confidence: 99%

“…Small accessory appendages arising from the left atrial wall have also been identified with cardiac CT, which have been referred to variably as aneurysms or diverticulae [4,5]. Pathologically, a diverticulum contains normal myocardial wall structure and contracts in synchrony with the rest of the atrium, whereas aneurysms do not contain myocytes and therefore do not exhibit contractile properties [4]. Cardiac multidetector CT is an evolving technique that is gaining increasing use as a noninvasive method of depicting the left atrium and PV anatomy prior to ablation [6,7,8].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Accessory left atrial diverticulae: contractile properties depicted with 64-slice cine-cardiac CT

Killeen

Ryan

MacErlane

et al. 2009

Int J Cardiovasc Imaging

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To assess the contractility of accessory left atrial appendages (LAAs) using multiphasic cardiac CT. We retrospectively analyzed the presence, location, size and contractile properties of accessory LAAs using multiphasic cardiac 64-slice CT in 102 consecutive patients (63 males, 39 females, mean age 57). Multiplanar reformats were used to create image planes in axial oblique, sagittal oblique and coronal oblique planes. For all appendages with an orifice diameter >or= 10 mm, axial and sagittal diameters and appendage volumes were recorded in atrial diastole and systole. Regression analysis was performed to assess which imaging appearances best predicted accessory appendage contractility. Twenty-three (23%) patients demonstrated an accessory LAA, all identified along the anterior LA wall. Dimensions for axial oblique (AOD) and sagittal oblique (SOD) diameters and sagittal oblique length (SOL) were 6.3-19, 3.4-20 and 5-21 mm, respectively. All appendages (>or=10 mm) demonstrated significant contraction during atrial systole (greatest diameter reduction was AOD [3.8 mm, 27%]). Significant correlations were noted between AOD-contraction and AOD (R = 0.57, P < 0.05) and SOD-contraction and AOD, SOD and SOL (R = 0.6, P < 0.05). Mean diverticulum volume in atrial diastole was 468.4 +/- 493 mm(3) and in systole was 171.2 +/- 122 mm(3), indicating a mean change in volume of 297.2 +/- 390 mm(3), P < 0.0001. Stepwise multiple regression analysis revealed SOL to be the strongest independent predictor of appendage contractility (R(2) = 0.86, P < 0.0001) followed by SOD (R(2) = 0.91, P < 0.0001). Accessory LAAs show significant contractile properties on cardiac CT. Those accessory LAAs with a large sagittal height or depth should be evaluated for contractile properties, and if present should be examined for ectopic activity during electrophysiological studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Accessory left atrial diverticulae: contractile properties depicted with 64-slice cine-cardiac CT

Killeen

Ryan

MacErlane

et al. 2009

Int J Cardiovasc Imaging

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“…The normal anatomy of the left atrial appendage has also been well studied [13]. During the routine clinical performance of coronary CT angiograms using a 64 slice ECG-gated CT scanner we have occasionally observed additional variations in the anatomy of the left atrium which are unusual and have been reported before as case reports or in small studies, such as atrial diverticuli [14][15][16][17][18], atrial aneurysms [19][20][21] and small accessory veins or fistulas originating from the left atrium which might look like diverticuli [12]. In this study we present an observational study of left atrial accessory appendages, and we report on the frequency and appearance of these lesser known anatomical variations of the left atrium in patients presenting for a clinical coronary CT angiogram using a 64 slice CT scanner.…”

Section: Introductionmentioning

confidence: 93%

Accessory appendages of the left atrium as seen during 64-slice coronary CT angiography

Duerinckx

Vanovermeire

2007

Int J Cardiovasc Imaging

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“…Differential diagnosis of the accessory cavity includes cor triatriatum, left atrial aneurysm, diverticulum, and pulmonary varix. [5][6][7] A prominent confluence of the left atrial appendage and left pulmonary vein is easily distinguished from the partitioning membrane of the cor triatriatum by TEE. 8 Echocardiography demonstrated a connection between the cavity and the peripheral pulmonary veins, suggesting that in this case it was not a left atrial aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Diagnosis of Pulmonary Vein Varix

Shiraishi

Tatsumi

Kimata

et al. 2003

Circ J

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ulmonary vein varix is a rare abnormality, often presenting as a pulmonary or mediastinal mass on chest roentgenograms, and pulmonary angiography, computed tomography (CT), or magnetic resonance imaging (MRI) is considered necessary for diagnosis. We describe our experience with an unusual case of pulmonary vein varix that was diagnosed noninvasively by echocardiography alone. Case ReportA 47-year-old woman was admitted because of chest discomfort. She did not have a history of cardiovascular disease and the results of physical examination, routine blood tests and electrocardiography were unremarkable. Chest radiography suggested a mediastinal mass inside the left cardiac border in the posteroanterior view ( Fig 1A) and behind the cardiac silhouette in the lateral view (Fig 1B). Two-dimensional transthoracic echocardiography (TTE) was performed. On the parasternal long-axis view, the motion and chamber size of the left ventricle were normal, and there was no enlargement of the left atrial or right ventricular chambers. On the short-axis view and apical 4-chamber view, an echo-free mass was observed outside the posterolateral wall of the left atrium (Fig 2A,B). There was no indentation of the left ventricular wall, suggesting that the mass was an extrapericardial structure. Color Doppler echocardiography detected blood flow from the mass into the left atrium (Fig 2C). Mitral regurgitation was not evident. Transesophageal echocardiography (TEE) more clearly demonstrated dilatation of the pulmonary vein in the proximal left lower lobe with normal intrapulmonary venous connections (Fig 3A,B). The varix communicated with the left atrium. The right pulmonary veins and left upper pulmonary vein were normal. The wall of the varix was Pulmonary vein varix is a rare abnormality, often resembling a pulmonary or mediastinal mass on chest radiographs, and pulmonary angiography has been the mainstay of diagnosis. An unusual case of pulmonary vein varix was clearly defined by echocardiography performed in a 47-year-old woman with chest discomfort who had been found to have an abnormal structure behind the cardiac silhouette on a chest radiograph.

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Left Atrial Diverticulum Associated With Severe Mitral Regurgitation

Cited by 27 publications

References 6 publications

Accessory left atrial diverticulae: contractile properties depicted with 64-slice cine-cardiac CT

Accessory left atrial diverticulae: contractile properties depicted with 64-slice cine-cardiac CT

Accessory appendages of the left atrium as seen during 64-slice coronary CT angiography

Echocardiographic Diagnosis of Pulmonary Vein Varix

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